Early Induction of Hypothermia During Cardiac Arrest Improves Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Who Undergo Emergency Cardiopulmonary Bypass and Percutaneous Coronary Intervention

Ken Nagao; Kimio Kikushima; Kazuhiro Watanabe; Eizo Tachibana; Yoshiteru Tominaga; Katsushige Tada; Mitsuru Ishii; Nobutaka Chiba; Asuka Kasai; Taketomo Soga; Masakazu Matsuzaki; Kei Nishikawa; Yutaka Tateda; Harumi Ikeda; Tsukasa Yagi

doi:10.1253/circj.CJ-09-0502

Cardiovascular Surgery

Early Induction of Hypothermia During Cardiac Arrest Improves Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Who Undergo Emergency Cardiopulmonary Bypass and Percutaneous Coronary Intervention

Ken Nagao, Kimio Kikushima, Kazuhiro Watanabe, Eizo Tachibana, Yoshiteru Tominaga, Katsushige Tada, Mitsuru Ishii, Nobutaka Chiba, Asuka Kasai, Taketomo Soga, Masakazu Matsuzaki, Kei Nishikawa, Yutaka Tateda, Harumi Ikeda, Tsukasa Yagi

Author information

Ken Nagao
Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Kimio Kikushima
Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Kazuhiro Watanabe
Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Eizo Tachibana
Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Yoshiteru Tominaga
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Katsushige Tada
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Mitsuru Ishii
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Nobutaka Chiba
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Asuka Kasai
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Taketomo Soga
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Masakazu Matsuzaki
Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Kei Nishikawa
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Yutaka Tateda
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Harumi Ikeda
Division of Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Tsukasa Yagi
Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital

Keywords: Cardiac arrest, Cardiopulmonary bypass, Cardiopulmonary resuscitation, Extracorporeal circulation, Hypothermia

JOURNAL FREE ACCESS

2010 Volume 74 Issue 1 Pages 77-85

DOI https://doi.org/10.1253/circj.CJ-09-0502

View "Advance Publication" version (November 27, 2009).

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Abstract

Background: Therapeutic hypothermia for comatose survivors of out-of-hospital cardiac arrest has demonstrated neurological benefits. Although early cooling during cardiac arrest enhances efficacy in animal studies, few clinical studies are available. Methods and Results: The 171 patients who failed to respond to conventional cardiopulmonary resuscitation were studied prospectively. Patients underwent emergency cardiopulmonary bypass (CPB) plus intra-aortic balloon pumping, with subsequent percutaneous coronary intervention (PCI) if needed. Mild hypothermia (34°C for 3 days) was induced during cardiac arrest or after return of spontaneous circulation. Of the 171 patients, 21 (12.3%) had a favorable neurological outcome at hospital discharge. An unadjusted rate of favorable outcome decreased in a stepwise fashion for increasing quartiles of collapse-to-34°C interval (P=0.016). An adjusted odds ratio for favorable outcome after collapse-to-CPB interval was 0.89 (95% confidence interval (CI) 0.82-0.97) and after CPB-to-34°C interval, 0.99 (95%CI 0.98-0.99) when collapse-to-34°C interval was divided into 2 components. Favorable neurological accuracy of a collapse-to-CPB interval at a cutoff of 55.5 min and CPB-to-34°C interval at a cutoff of 21.5 min was 85.4% and 89.5%, respectively. Conclusions: Early attainment of a core temperature had neurological benefits for patients with out-of-hospital cardiac arrest who underwent CPB and PCI. (Circ J 2010; 74: 77 - 85)

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